While docs say the benefits outweigh the risks, medical radiation can lead to secondary cancers

"Today's radiation is targeted to the specific area,'' said Dr. Rogerio Neves. "It's important not to scare people."

View full sizeJanice Shepler has had reoccurring skin cancer problems after being treated with radiation for acne decades ago DAN GLEITER, The Patriot-News, 2013

Janice Shepler suffered with severe acne as a child and, as unbelievable as it may sound today, her prescribed treatment was frequent radiation, administered by her doctor.

For that “cure,” Shepler, now 72, has paid a steep price: Ten to 15 surgeries and still counting for basal cell skin cancer on her face.

“This was the mode of treatment then. Starting at around age 10, I had radiation every week, then very other week and then once a month for two years,” said Shepler, who grew up in Colonial Park and now lives in Lower Paxton Twp. “After the radiation, the doctor would lay me down under ultraviolet light to treat the acne on my chest and back.”

Although it sounds incredible now, her doctor also told her to lie in the sun as long as she could stand it to get sunburn so that her skin would peel off, she said. “I was blonde and I certainly did burn. After I peeled, I loved the beautiful skin I had until it broke out again,” she said.

While radiation wouldn’t be used to treat acne now, it is, of course, used to treat cancer. It still carries some risk of causing a secondary cancer, but doctors say the risk is extremely small and the benefit of treating the primary cancer far outweigh that small risk.

Shepler got her first skin cancer when she was in her early 30s and has also had melanoma in the nape of her neck, which she also attributes to the radiation.

Like many patients who underwent such radiation treatments years ago before all the dangers were appreciated, Shepler was unaware that the cost could be cancer.

“Back then, we thought radiation was wonderful and we used it for everything, things with a lot of inflammation that we didn’t have medications for,” said Dr. Christine Cassel-Mackley, of Brownstone Dermatology Associates in Hummelstown. “I see many patients who had radiation for acne and now have basal cell skin cancer – 40 to 60 basal cells on their face.”

Shepler, who gets a thorough skin check from Cassel-Mackley every six months, is also under surveillance for thyroid cancer, also linked to radiation.

“I’m not bitter at all; I feel blessed,” said Shepler, who had a very difficult time getting pregnant and

wonders if radiation impacted her fertility. “I don’t have any cancer of any internal organs, which I think is amazing considering the amount of radiation I had in very formative years of my body.”

Shepler’s father made her promise never to tell her mother about the skin cancer. “I know my mother thought she was doing the best thing for me, even though she had to drag me there,” she said. “The doctor also thought he was doing the best thing to treat me, just like doctors are using new treatments today and we don’t know what long-term effects there may be.”

Doctors insist that modern radiation treatments are far safer.

“Today’s radiation is very targeted to the specific area. They can use particles of radiation that attack the tumor in a very focused way,” said Dr. Rogerio Neves, plastic surgeon and surgical oncologist specializing in skin cancer and deputy director of the Penn State Hershey Melanoma Center. “It’s important not to scare people because the risk is so small – I see one case or so every year – but still, we must tell them about the risk.”

Radiation therapy uses high doses of ionizing radiation – much higher doses than used in imaging tests – that kill the cancer cells but that can also cause mutations on chromosomes in other cells, which can lead to a secondary cancer, sometimes 10 or more years later, Neves said.

“It takes a long time for these cells to hide from the immune system that would usually attack them and to get from one cell to millions of cells,” he said.

The three cancers most strongly linked with radiation are thyroid, breast and leukemia, according to the National Council on Radiation Protection and Measurements. The younger the patient when treated with radiation, the greater the lifetime risk of developing a secondary radiation-related cancer.

“Women treated for lymphomas in the chest area in the ages of 13-29 have a 30 percent chance of developing breast cancer, and because that is a high risk, they should begin screening earlier than other women,” said Dr. Heath B. Mackley, radiation oncologist at Penn State Hershey Cancer Institute. “For women in this group, we usually recommend beginning mammogram screening by age 30, and to perform self breast exams in their 20s.”

Radiation-induced sarcomas – cancers that arise from fat, muscle or bone, often in the legs and arms – are uncommon, but possible from radiation used to treat any type of cancer, Mackley said.

No special screening is recommended, however, because the risk is so low, he said.

Though it’s rare, it’s possible for a woman who had radiation for breast cancer to end up with basal cell skin cancer in the area where she was radiated.

“Basal cell carcinoma is so common, it would be difficult to say it’s definitely due to radiation, but you could say they are related since the breast is not an area that would see a lot of sun,” Mackley said. Radiation burns to the breast can be a risk for squamous cell carcinoma, as can radiation burns to the skin during a cardiac catheterization, she said.

Certain types of chemotherapy and drugs used in transplant patients also increase risk for skin cancer, she said.

Treatment aside, Cassel-Mackley said there is a connection between breast cancer and melanoma.

“It’s interesting how many of my melanoma patients have had breast cancer, and vice-versa,” she said. “It has to do with genetics. A series of mutations must occur for cancer to develop. The current thinking is that you’re born with a common mutation that causes both.”

She tells women she treats for melanoma to be sure to get their mammograms and do self-exams. She tells all patients to ask a doctor for a skin check annually and self-monitor in between.

“Certainly if you have had a cancer and you had radiation, you should be looking for lesions,” she said. “Look for the ‘ugly ducklings,’ moles that look different in color or shape or texture from all your other moles.”

Staying safe in the sun

Ultraviolet (UV) rays are an invisible form of radiation that can penetrate skin and damage skin cells.

Sunburns are a sign of skin damage. The UV rays can cause skin damage during any season or at any temperature. The rays can also cause skin spots, skin cancer, eye problems and wrinkles.

Here are some tips to protect yourself when you’re out in the sun:

- Stay out of the sun when it is strongest (between 10 a.m. and 4 p.m.)- Use sunscreen with an SPF of 15 or higher.- Wear protective clothing. - Wear wraparound sunglasses that provide 100 percent UV ray protection.- Avoid sunlamps and tanning beds. - Check your skin regularly for changes in the size, shape, color or feel of birthmarks, moles and spots. Such changes are a sign of skin cancer.